How engineers and doctors are reinventing healthcare

Life-saving lessons

Linking engineering and medicine has led to better diagnostics, drugs and treatments. But it’s not always easy to collaborate successfully.

Europe is at the forefront of medical technology: 25,000 companies now employ 575,000 people and produce more patent applications (12,200 in 2016) than any other field – even computer technology and digital communication.

Innovation is the key to maintaining this position, yet austerity and strained budgets are forcing many countries to curb healthcare spending just as ageing populations and chronic diseases place ever greater pressure on services. As a result, providers not only need to see health benefits in new technology but also cost and efficiency savings.

The best way to meet new medtech needs is to have physicians and engineers work together. The pragmatism and technical savvy of engineers often complement the medical profession’s understanding of practical challenges in a clinical setting. “The critical mass of people and resources delivers reliable results that no partner could have delivered alone”, explains Pierre Meulien, executive director of the Innovative Medicines Initiative in Brussels. “Yet some partners are concerned about intellectual property and there are often large differences in the culture and way of working.” Forming a crack interdisciplinary team is, in short, no mean feat.

Have a little patience

MedoPad is a London-based company founded in 2011 with the goal of improving healthcare through technology. “Doctors and nurses had troubles accessing the information they needed on a daily basis”, recalls co-founder Rich Khatib. “The iPad had just been invented and we thought, what if we could provide these data through mobile devices 24/7 at the point of care?” Working closely with industry, hospital groups and IT teams, MedoPad went to work.

Six years later, many doctors now view medical records, lab results and images through MedoPad’s mobile solutions. Essentially, MedoPad links all relevant data in a hospital to deliver a patient’s records at the touch of an iPad, and then offers tools to use those data effectively. Recent successes include the Harley Street Clinic deploying Medopad’s remote patient monitoring solution for its paediatric cancer patients, and the Leg Ulcer Charity making MedoPad’s app available to 25,000 patients.

Obvious as this approach may seem, MedoPad’s journey has been fraught with difficulties. “It’s a very slow industry”, says Khatib, “so you have to have a lot of resilience and patience”. The biggest hurdle, according to Khatib, is gaining approvals from various stakeholders – from ethical to security to compliance.

Be agile

Based on the outskirts of Paris, DBV Technologies was created in 2002 to tackle a specific problem that Pierre-Henri Benhamou and Christophe Dupont identified in their clinic. Both paediatric gastroenterologists, they noticed an increasing number of patients with serious gastrointestinal issues caused by food allergies for which there were no safe treatment options. With the help of engineer Bertrand Dupont, DBV Technologies developed an original epicutaneous patch that would allow patients to be desensitised through the skin.

Their Viaskin patch delivers biologically active compounds to the immune system through intact skin without allowing the antigen to pass into the bloodstream, where it could cause life-threatening allergic reactions. Developed for peanut, milk and egg allergies, Viaskin is in clinical development. “Viaskin Peanut, our lead product candidate, is currently in phase III clinical trials for peanut-allergic children ages 4-11, with results expected in the second half of 2017”, says COO David Schilansky. He argues that collaboration across various departments, including medical, scientific and engineering teams, has been central to developing the Viaskin platform. “R&D employees account for roughly half our workforce”, he notes. “The ability to remain agile and to continue to learn while working together across teams is key to the company’s success.”

Involve users

Siemens Healthineers, a healthcare business of German technology giant Siemens, focuses on diagnostic and therapeutic imaging, laboratory diagnostics and molecular medicine. Recently they designed a novel mobile computed tomography (CT) system that reduces cost, increases consistency and simplifies workflow. Florian Belohlavek, head of Product Marketing Management, explains that the mobile workflow, supported by wireless tablets, is a completely new way of operating the CT scanner.

Called the SOMATOM go. platform, the system features an operating concept that guides users through a standard examination in a few steps that tell personnel how to position a patient, set the scan parameters and prepare images for diagnosis. This ensures the steps are precisely reproducible, which is crucial for follow-up examinations.

“The SOMATOM go. platform was designed together with customers for our customers”, says Belohlavek. To create the new system, the company surveyed more than 500 radiologists, radiology assistants, CFOs, patients and referring physicians, all focused on features that would make the respondents’ daily work easier. Belohlavek’s advice for anyone thinking of developing medical technology? “Include as many customers as possible in your process.”

Cell and tissue engineering is one of many fields in which partnership between engineers and physicians can produce remarkable advances. Dirk Busch, director of the Institute of Medical Microbiology, Immunology and Hygiene at the Technical University of Munich (TUM) tells us how.

TECHNOLOGISTHow do medicine and engineering come together in your current work?

DIRK BUSCH We are trying to isolate and subsequently genetically modify defined types of immune cells to convert them into powerful living drugs that can fight infections or cancer. For this purpose, we need to develop technologies and machines that can be transferred to clean rooms so that we can engineer these cells under appropriate conditions. We recently established such a facility called TUMCells to foster this process of clinical engineering.

TECHNOLOGIST What is the greatest challenge when managing a team developing medical technologies?

DIRK BUSCH Medical technologies not only have to work precisely, robustly and reliably. They also have to fulfil additional criteria specific to clinical applications in humans, such as sterility, certified machinery, biocompatible materials, in vivo safety and toxicity.

TECHNOLOGISTWhat has been your greatest physician-engineer success?

DIRK BUSCH We have developed several new technologies, such as the so-called Streptamer technology, for clinical cell-processing and purification, from which a spin-off company called Stage Cell Therapeutics recently merged with the US company Juno Therapeutics in a $200-million deal. By trying to bring different disciplines together, especially the involvement of engineers, we advance the field of cell and tissue engineering.

TECHNOLOGISTAre there specific difficulties in Europe?

DIRK BUSCH Engineers are problem solvers who bring new technologies into a format that make them applicable as medical diagnostics or therapeutics. We certainly need more engineers trained in medical applications and more centres to educate bioengineers with a specific understanding of medical problems.

► Medical scientist

Usually educated to the PhD level, medical scientists work in universities, pharmaceutical companies and hospitals, conducting experiments to increase understanding of human health and diseases. They also develop and improve drugs, treatments and other related products.

► Clinical data scientist

Combining an aptitude for statistics and computer science with experience in healthcare, clinical data scientists manage the technologies used in clinical studies, while also being able to interpret data.

► Medical VR designer

With cutting-edge knowledge of virtual-reality software and an understanding of deep medical concepts, medical VR designers explore the benefits that this technology can bring to a medical setting – from improving teaching by experiencing surgical operations remotely to speeding up recovery after a stroke.

Engineering healthier humans

Drawing on their knowledge of algorithms, design and materials, engineers can help improve healthcare in many arenas, from diagnostics to drug delivery. This infographic presents some of Europe’s most promising projects.

1. HIGH-PRECISION ROBOT FOR COCHLEAR IMPLANTATION

Researchers at Bern University Hospital and the University of Bern have combined surgical planning software and a robotic drill to access the cochlea via a 2.5 mm diameter tunnel behind the ear.

Engineering innovation:

The size and scale of the procedure means the robot drills without direct operation. Just as avionics allows pilots to fly planes based solely on cockpit read-outs, the surgical robot can perform procedures a surgeon cannot execute manually.

2. SOLAR CELLS TAHT RESTORE SIGHT

Medical challenge:

Retinal diseases are the most common cause of visual loss in developed nations, due to the degeneration of retinal photoreceptors.

Solution:

Rasmus Schmidt Davidsen’s team at the Technical University of Denmark (DTU) is building an implantable chip that may be able to reverse blindness caused by this deterioration.

Engineering innovation:

The chip will contain thousands of specially developed nanostructured silicon cells. “When illuminated from outside the eye, each cell produces a current”, says Schmidt Davidsen. “If the electrodes are in close proximity to neurons in the eye, this current may activate the neurons, generating an electrical signal directly from light hitting the eye.”

3. DNA COMPUTERS THAT DELIVER DRUGS

Medical challenge:

Traditional blood tests can’t persistently monitor antibodies, which are important in providing better control of medication for conditions such as rheumatism, Crohn’s Disease, influenza and AIDS.

The work exploits a process called hybridisation, in which a single strand from one DNA molecule attaches to another DNA molecule. Certain DNA combinations can only occur in the presence of an antibody, so combining the right molecules creates a signal when hybridisation occurs.

4. PACEMAKERS POWERED BY THE HUMAN HEART

Medical challenge:

Vibration harvesting systems are useful for extracting and storing energy. The process works well at the scale of large machinery, but can’t be used in implantable medical devices that typically operate below 100 Hz, due to the limited stiffness of conventional silicon.

Solution:

New engineering techniques have helped the EU-funded MANPOWER project extract and store energy from vibrations as tiny as the beating of a human heart, opening the door to self-powered pacemakers.

Engineering innovation:

“The main innovations were the development of materials and electronic structures for the two core components of a low-frequency energy harvester: the energy harvester and the charge storage device”, says coordinator Dr Cian Ó Murchú from the Tyndall National Institute in Ireland.

5. PORTABLE ULTRASOUND SCANNERS

To make handheld ultrasound instruments, the electronics and signal processing in the scanner must be radically changed. DTU’s Jørgen Arendt Jensen is working on just such a solution: “We have developed a new way to create images called synthetic aperture imaging”, he says.

Engineering innovation:

“Instead of looking in one direction at a time, we look in all directions simultaneously. We can display up to 1,000 images per second, allowing us to precisely observe heart beat and blood flow.” The hope is that these devices could become ubiquitous in ambulances, as well as in trauma and labour wards.

6. A PROTHESIS WITH FEELING

Medical challenge:

Human skin is an incredibly complex organ capable of detecting pressure, temperature and texture through neural sensors. Recent innovations have aimed to recreate this sensitivity for amputees.

Solution:

Stéphanie Lacour and her team at the École Polytechnique Fédérale de Lausanne have developed tiny sensors implanted in a glove, which can be worn on a hand prosthesis and linked to the user’s nervous system to restore a sense of touch.

Engineering innovation:

The researchers put an electronic circuit on an elastic material called elastomer and added a thin layer of gold to maintain conductivity when the glove is stretched. The result is a critical step towards hand prostheses with the ability to feel.

Welcome to Health Valley

Building on skills honed over the centuries, western Switzerland has become a world leader in biotech.

More than 1,000 companies, start-ups, research and training centres and close to 5,000 scientists are currently operating in Switzerland’s Health Valley. Named as a nod to California’s Silicon Valley, this phenomenon in the country’s French-speaking area is now one of the world’s most dynamic ecosystems in the life sciences and health industry, competing intensely with similar regions in the US.

For Claude Joris, secretary general of the BioAlps association, Health Valley isn’t just a name. Since 2003, it has experienced strong growth that is supported by politicians because of the industry’s high added value.

As evidence, he cites the more than 16,000 people employed in the pharmaceutical industry, agrochemistry, medical engineering and biotechnological research. This includes 935 companies, ranging from start-ups to multinationals. There are also two major hospitals and six universities. These numbers put it on a level with Silicon Valley and Boston, which in 2010 employed 15,000 and 14,000 people, respectively, in the biomedical field, according to financial website The Balance.

While biopharmaceutical giants like Johnson & Johnson, GlaxoSmithKline and Merck-Serono are present in Health Valley, their R&D departments are not. “These centres would strengthen the local ecosystem”, says Joris, because small companies and start-ups develop their projects by working with the big companies. Even so, this is not a major handicap for the region, says Robert Lütjens, research director at the biopharmaceutical company Addex Therapeutics. “Complementary approaches, rather than proximity, create the right circumstances for collaboration.”

Cautious investors

A key factor for developing a profitable ecosystem is venture capital, of which Health Valley has its fair share. Last year, according to Joris, more than €550 million in venture capital came into local life sciences, or 7.4% of all investment in the industry. These figures are comparable to those for Boston and Silicon Valley. Joris adds that over the past few years Singapore has lost some energy in the life sciences, and that while China has agreed to significant investments, it is still struggling to develop its start-up sector. Despite these encouraging figures, investment in Switzerland is still falling short. “Investors here take fewer risks than in the US”, says Matthias Lutolf, director of the Interfaculty Institute of Bioengineering at the École Polytechnique Fédérale de Lausanne (EPFL). Before the 2008 financial crisis, Switzerland was one of the most attractive places for biomedical start-ups looking to go public. The numbers have not returned to their pre-2008 levels, says Joris, “possibly because of risk aversion on the Swiss stock market and the shock that still remains from 2008”. Consequently, companies in Health Valley are looking more towards large foreign stock exchanges such as NASDAQ and Euronext.

Support from Swiss watchmaking expertise

One reason for Switzerland’s attractiveness is the plethora of ideas emerging from its schools and scientists. The country ranked number one, ahead of the US and China, in the 2016 Global Innovation Index. A major Swiss strength, according to Joris, is the ability to build on pillars of Swiss expertise. The medical-engineering industry developed thanks to Swiss watchmaking, which honed microtechnical skills – such as meticulous work, precision and perseverance – over the centuries. One example is Valtronic, which began in the Vallée de Joux, a hotspot for Swiss watchmaking. Now located at the EPFL Innovation Park, Valtronic develops miniature electronic products and mechatronic systems for medical and industrial use. Another innovation that began on Swiss soil is regenHU, whose 15 employees have developed 3D bio-printers able to produce synthetic tissues and organs from living cells. The most prominent example of this evolution is EPFL itself. Known mostly as a high-level engineering school as recently as 15 years ago, it is now also a leading player in the life sciences. “This success is in line with the vision held by former president Patrick Aebischer and his desire to bring together medical technology, information technology, nanotechnology and biotechnology”, says Lutolf.

To foster dynamic collaborations, the region around EPFL is now home to centres that bring together various skills and expertise. Examples include the future AGORA Cancer Centre in Lausanne and Campus Biotech in Geneva, which is home to local and international physicians, researchers and engineers who work together to apply neurotechnology from research to clinical products.

Swiss global players

Matthias Lutolf, director of the Interfaculty Institute of Bioengineering at the École Polytechnique Fédérale de Lausanne, regrets that investors in Switzerland take fewer risks than in the US.

Sophia Genetics: genomic analysis

Started at the EPFL Innovation Park in 2011, Sophia Genetics is gradually emerging as the world leader in genomic data analysis, with 270 hospitals in 47 countries employing its services. Using high-speed DNA sequencing to analyse and process massive data from patients, the company recently opened a new centre at Geneva’s Campus Biotech.

Addex: therapeutic molecules

Founded in Geneva 15 years ago, Addex Therapeutics develops treatments for neurological disorders. The company recently celebrated a major success: a study from Belgian laboratory Janssen, a subsidiary of Johnson & Johnson, demonstrated the positive effects of its molecule ADX71149 for treating epilepsy. A few months ago, Addex received $835,000 from the Michael J. Fox Foundation to continue developing the molecule in the hopes of treating Parkinson’s disease.

Anokion: Autoimmune treatments

Marketing a technology that reduces immunological tolerance in patients, Anokion has shown promising results in immunological engineering. It can be used to reduce the response induced by protein-based treatments used to treat autoimmune diseases. The technology has been well received by investors and pharmaceutical companies. Anokion has an office at EPFL and recently moved its centre of operations to Cambridge in the US.

How to mimic organs

Building the perfect implant, testing a new drug or predicting the evolution of a tumour: the medical challenges around organ simulation are high. Here are three different ways to do it.

Medicine: The debate over Big Data

Should doctors have access to huge datasets? The potential to improve healthcare is obvious, but privacy remains equally important.

From detecting how Zika or Ebola might spread to predicting surgical outcomes, from anticipating the side effects of drugs to the likelihood of readmission, Big Data can help revolutionise healthcare. But while Wil van der Aalst, a computer scientist at the Eindhoven University of Technology, champions digging deep into patient data, Nathan Lea of University College London’s Institute of Health Informatics sees big hurdles for this practice.

TECHNOLOGISTHow confident are you that large-scale analysis of patient data can help Europe’s healthcare systems?

WIL VAN DER AALST Hospitals collect huge amounts of data that provide unprecedented opportunities for process mining, where the focus is on end-to-end behaviour involving patients, staff and machines. For instance, we can predict surgical outcomes in specific demographics or compare the quality of different intensive-care units.

NATHAN LEA It’s not yet clear what Big Data’s usefulness may be in specific contexts. How do you fit a square peg into a hole if you haven’t even discerned its shape? There are some very positive programmes around. For example, the European Medical Information Framework, which uses Big Data to identify subjects with Alzheimer’s disease who have not yet reached the stage of dementia. By connecting relevant studies across Europe, the project is driving large-scale research on risk factors for neurodegenerative disorders. However, such programmes generally require a lot of time and money.

TECHNOLOGISTWhat are the challenges for Big Data and informatics in a privacy-critical healthcare setting?

WIL VAN DER AALST On one hand, people do not see the complexity of the challenges; on the other hand, there is little awareness of the solutions that currently exist. Access control is one issue: we need to understand where data access is unjustified. Of course, doctors need access to information, but first we need to ensure that we protect patients; only then can we think about analysing their data. Data mining helps improve processes such as access control by asking deeper questions about outliers, but hospitals aren’t yet applying such solutions on a daily basis.

NATHaN LEA From check-ups to emergencies, healthcare is based on a confidential therapeutic relationship between medical professional and patient in different contexts. Once I see good examples of meaningful intelligence, my confidence in it will grow.

TECHNOLOGISTCan you outline the most promising approaches for building a coherent new data ecosystem that protects patient privacy?

WIL VAN DER AALST One approach is to make use of various encryption types, such as homomorphic encryption. That means we can encrypt event data in a way that allows it to be analysed for a specific purpose, so it isn’t decrypted first and therefore can’t lead back to the individual patient.

NATHAN LEA In the security sector, 100% guarantees don’t exist. The risk is re-identification of an individual and their records; you’ve got to accept that no matter how smart the encryption techniques, there will always be some error. We must view security, privacy and the challenges around Big Data as weaving a tapestry. It’s a tapestry of policy, procedure, best practice and guidance, and the manner in which they’re sewn together is most important. While projects are working together to build resources that manage vast datasets, linking records from multiple sources should be performed only at the local level. If hospitals and social-care organisations are already collecting and linking data, others should not be repeating that work. Keep the data within a context where use is already permitted, legal and ongoing.